b. American Indians

Section 1902(xx)(9)(A)(ii)(II) of the Act establishes a broad exclusion for American Indians. For purposes of this exclusion, we are adopting the existing definition of “Indian” at § 447.51 for the specified excluded individual category at § 435.554(c)(2). Under existing eligibility rules, certain American Indians are exempt from cost sharing in Medicaid and CHIP and may receive special types of income that are not included in the MAGI calculation. They may also be eligible for special enrollment periods and cost sharing reductions for qualified health plans purchased on the Health Insurance Exchange. State Medicaid applications ask questions to identify who might be eligible for these protections (that is, cost sharing exemptions and deductions from income for Medicaid and CHIP and special enrollment periods and cost sharing reductions on the Health Insurance Exchange). The application also requests information about American Indian status as part of the race question, which is optional.

States should use these existing data collected on the application and follow their existing verification policies to verify that an individual qualifies as a specified excluded individual in this category. Notably, unlike some other exclusions which may be time limited or based on conditions that are subject to change, once verified, States do not need to reverify someone's status as an American Indian or qualification as a specified excluded individual on this basis, consistent with existing verification policy related to information not subject to change.